Deep Brain Stimulation

Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) is a surgical procedure for the treatment of neurological disorders (such as Parkinson’s disease) in which electrical stimulation is delivered to specific areas of the brain by one or more electrodes that are implanted in the brain and are attached by a wire to a device which generates electrical pulses and is usually implanted in the upper chest. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications.

DBS uses a surgically implanted medical device called a neurostimulator. It has function is similar to a heart pacemaker which is to deliver electrical stimulation on targeted areas. In this matter, the targeted area is in the brain which responsible in movement control and block the abnormal nerve signals. Therefore, it will be able to reduce tremor and Parkinson’s disease symptoms.

Preparations:

The first important step is to locate the exact brain area where electrical nerve signals generate the Parkinson’s disease symptoms. A neurosurgeon will use magnetic resonance imaging (MRI) or computed tomography (CT) scan.  Some surgeons may also use microelectrode recording to monitors the activity of nerve cells in the target area.

The DBS system consists of three components:

• The lead, or electrode, is a thin, insulated wire that is implanted in the brain.
• The extension is also an insulated wire, which is placed under the skin and connects the lead to the neurostimulator.
• The neurostimulator, usually implanted under the skin near the collarbone. The neurostimulator send the electrical pulses  through the extension wire to the lead in the appropriate location in the brain. These impulses block the electrical signals that cause Parkinson’s Disease symptoms.

The Procedure of DBS

During surgery, patient may remain awake, or the patient may be asleep (under general anesthesia). The three DBS components are placed into the patient’s body. A week after the surgical procedure, the neurostimulator’s settings are fine-tuned using a handheld programmer. The settings may be adjusted over time to determine the best combination of electrical stimulation and medication for the individual person.

What is the Prognosis?

Although some patients still need to take medication after undergoing DBS, many patients experience considerable reduction of their symptoms and are able to greatly reduce their medications. The amount of reduction varies from patient to patient but can be considerably reduced in most patients. The reduction in dose of medication leads to a significant improvement in side effects such as dyskinesia (involuntary movements caused by long-term use of levodopa).

How do I know if I’m a candidate for deep brain stimulation (DBS)?

• You have had Parkinson’s Disease symptoms for at least five years.
• After a consistent and regular medication dosing, you still have “on/off” fluctuations.
• You have dyskinesias.
• You are unable to tolerate the side effects of anti-parkinson’s medications.
• Medications fail to control your tremor.

Food of thought after you decided to get a DBS procedure:

o   WHO is Going to do the surgery?

Ask the neurosurgeon about his or her experiences specifically related to your condition. You may also consider the quality of care at the hospital where the neurosurgeon can treat patients.

o   WHICH DBS device is right for me?

All DBS devices have the same three basic components and work the same principles. However, there are variations in the components, such as batteries longevity and capabilities to deliver electrical stimulation in varied ways, or record brain signals for possible correlation with symptoms.

When thinking about DBS systems, things to be considered:

The shape, weight, and size of neurostimulator device

Neurostimulator device will be implanted under the skin. Big, heavy, and bulky device may cause discomfort, pain and higher infection risk.

·         Battery longevity

• Rechargeable batteries may require daily or weekly recharging. It can last 15 to 25 years, which may mean fewer surgical procedures to replace them.

• Non-rechargeable batteries averagely last three to five years. It will depend on your device and individual settings. No need to recharge the battery, but you may need to do another simple surgery to replace the battery.

·         MRI conditionality

All DBS devices are MRI “conditional,” meaning that they are safe for MRI scans if certain conditions are met. If you anticipate needing regular MRIs for an ongoing medical condition, ask for a device with broader range of MRI compatibility.

o   HOW is the supporting or follow up team service

One month post procedure and every three months subsequently you may need to adjust the DBS program regularly. You can follow up with your neurosurgeon or if you are unable to meet your doctor, the supporting follow up team will help you to adjust the DBS program. It will be done using an iPad or Samsung tablet.

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